The Efficacy of Reprocessing Unsatisfactory Cervicovaginal ThinPrep Specimens With and Without Glacial Acetic Acid

Abstract

We sought to determine the efficacy of remaking initially unsatisfactory cervicovaginal ThinPrep (Cytyc, Boxborough, MA) specimens with and without the addition of glacial acetic acid (GAA) and the effect on human papilloma virus (HPV) Hybrid Capture II (HC2; Digene, Gaithersburg, MD) testing. A total of 583 initially unsatisfactory ThinPrep slide preparations were identified, and remakes were made with the residual in the PreservCyt (Cytyc) vials with (n = 455) or without (n = 128) GAA. Clinical follow-up information was obtained. The addition of GAA resulted in a 56.5% reduction in unsatisfactory cases, compared with a 26.6% reduction without GAA. Neoplasia and atypia were detected in the reprocessed specimens. The addition of GAA resulted in false-positive HC2 test results in 10 of 10 cases. Neutralization of the specimen may reverse this effect. Reprocessing unsatisfactory ThinPrep specimens with GAA can substantially reduce the overall unsatisfactory rate and result in the detection of significant lesions. However, the addition of GAA can result in false-positive results on HC2 HPV tests.

Reprocessing unsatisfactory ThinPrep Papanicolaou test specimens increases sample adequacy and detection of significant cervicovaginal lesions

“…In the current study, we also found that reprocessing unsatisfactory samples resulted in a 62.98% improvement in the reclassification of unsatisfactory TP samples, essentially confirming the results of Bentz et al (Table 4). In addition, we also found that, once the 23 However, the rate of abnormalities in that study was lower compared with the rate reported by Ransdell et al 21 In their study, Ransdell et al showed that 26% of their unsatisfactory Pap smears belonged to patients who had a history of epithelial lesions. Subsequent follow-up of those patients showed SIL in 16% of patients.…”

“…23,[25][26][27] In addition, it has reduced the overall unsatisfactory rate by 50 -80% compared with the conventional Pap smear method. 23,[25][26][27] In addition, the TP method allows reprocessing of unsatisfactory specimens, which is not possible otherwise with conventional smears. 23 Earlier studies demonstrated that routine preparation of additional slides from the TP PreservCyt vial added no additional information.…”

“…23,[25][26][27] In addition, the TP method allows reprocessing of unsatisfactory specimens, which is not possible otherwise with conventional smears. 23 Earlier studies demonstrated that routine preparation of additional slides from the TP PreservCyt vial added no additional information. 28 -30 In contrast, a recent study showed that additional TP slides from the cellular residue of the PreservCyt vial were helpful for making definitive diagnoses in difficult cervicovaginal specimens that initially were interpreted as ASCUS, AGUS, LSIL, or HSIL.…”

“…11 In this regard, although it is not approved by the FDA, several laboratories have employed an acetic-acid wash to the TP test and found further significant improvement in the unsatisfactory rate and increased detection of cervicovaginal abnormalities after reprocessing. 23,24 This is based on the premise that an acetic-acid wash will lyse the excessive blood that may clog the TP filters and prevent delivery of the epithelial components to the slides.…”

Performance of cytology and human papillomavirus testing in relation to the menstrual cycle

“…the menstrual cycle were associated with the highest frequency of unsatisfactory samples (Vooijs et al, 1987). Although addition of glacial acetic acid to bloody cervical specimens may reduce the frequency of unsatisfactory thin-layer slides, data suggest that this treatment may cause false positive HC2 results, thus limiting the subsequent utility of such specimens (Agoff et al, 2002). Specimens collected early in the cycle yielded the high frequency of HSIL cytology overall and among women who were diagnosed with histologic CIN2 þ , which could reflect improved sensitivity of these samples compared to those obtained at other times in the cycle.…”